Home surveillance program prevents interstage mortality after the Norwood procedure

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Management
• Infant Health Monitoring

Background:

• Interstage mortality remains a significant concern for infants with complex congenital heart disease following initial surgical palliation.
• Early identification of physiologic deterioration is crucial for improving outcomes during the interstage period.

Purpose of the Study:

• To evaluate the effectiveness of a home surveillance program in reducing interstage mortality.
• To identify early physiologic indicators of increased risk for interstage death.

Main Methods:

• A home surveillance program was developed, utilizing infant scales and pulse oximeters for daily monitoring of weight and arterial oxygen saturation.
• Parents were instructed to report specific thresholds for oxygen saturation decline, acute weight loss, or failure to gain weight.
• Infants were divided into two groups: those before surveillance initiation (Group A) and those with surveillance (Group B).

Main Results:

• Interstage mortality was significantly lower in the home surveillance group (0%) compared to the control group (15.8%).
• Surveillance criteria were met by 13 infants, leading to earlier stage 2 palliation (3.7 months) compared to those without complications (5.2 months).
• Reduced growth velocity was observed between 4-5 months post-Norwood procedure, with a plateau thereafter.

Conclusions:

• Daily home surveillance effectively identifies high-risk infants, enabling timely interventions like early stage 2 palliation and improving interstage survival.
• The findings suggest that diminished growth 4-5 months post-Norwood procedure warrants consideration for earlier stage 2 palliation, potentially beyond 5 months of age.